Project Summary/Abstract Minnesota HealthSolutions Corporation and Children?s Hospital Los Angeles propose the development and validation of a novel methodology for effective triggering and synchronization of non-invasive ventilation (NIV) for infants and children in the intensive care unit (ICU). Technology advancements in NIV have improved outcomes for critically ill patients, but unfortunately, most neonates and children do not achieve the full benefits of NIV, particularly bi-level ventilation, because they are unable to effectively synchronize breaths with the non- invasive ventilator. This is because pediatric NIV patient interface appliances often have significant air leakage, which, when combined with the fact that children generate smaller changes in airway flow, prevents the ventilator from reliably sensing patient effort. The resulting ventilator timed breaths are asynchronous with patient effort, leading to ineffective ventilation, higher patient effort of breathing, and worsening lung injury. The lack of effective NIV leads to higher rates of intubation in neonates and young children, with unnecessary exposure to medications which harm the developing mind, longer ICU lengths of stay, and iatrogenic complications such as infection, ventilator induced diaphragm dysfunction, and post-ICU impairment in quality of life. Ventilator manufacturers are searching for solutions to this problem because many previously developed products have not gained wide scale commercial use since they are invasive or have substantial technical limitations when applied to the infant or neonate. The proposed project will develop, refine and initially validate a novel hierarchical ventilator trigger algorithm and test this trigger system in a newly-collected, real world ICU dataset involving neonates, infants, and children in the neonatal and pediatric ICU at Children?s Hospital Los Angeles.